Loss Of Use

[windy city]

Placed a claim for lou of use of lower extremities which is being caused by my S/C disabilities. Recieaved letter from VA saying that they got my claim. Enclosed was a paper informing me that if order to get the smc at the R2 I must present a statement from a licensed health care. Well my civilian doctor put me in a home exercise program for my back,legs and hips for which my wife is supervising and my physical therapiest is going to check twice a month. Need soem kind of advice on what to do.Thanks.

[sixthscents]

Um for an R2 rating I think they are looking for a bit more detailed information than that. Such as catheters, ability to raise from a sitting position etc. I Think, its under CFR 38 3.352...

) Basic criteria for the higher level aid and attendance allowance.

(1) A veteran is entitled to the higher level aid and attendance allowance authorized by §3.350(h) in lieu of the regular aid and attendance allowance when all of the following conditions are met:

(i) The veteran is entitled to the compensation authorized under 38 U.S.C. 1114(o), or the maximum rate of compensation authorized under 38 U.S.C. 1114(p).

(ii) The veteran meets the requirements for entitlement to the regular aid and attendance allowance in paragraph (a) of this section.

(iii) The veteran needs a “higher level of care” (as defined in paragraph (B)(2) of this section) than is required to establish entitlement to the regular aid and attendance allowance, and in the absence of the provision of such higher level of care the veteran would require hospitalization, nursing home care, or other residential institutional care.

(2) Need for a higher level of care shall be considered to be need for personal health-care services provided on a daily basis in the veteran’s home by a person who is licensed to provide such services or who provides such services under the regular supervision of a licensed health-care professional. Personal health-care services include (but are not limited to) such services as physical therapy, administration of injections, placement of indwelling catheters, and the changing of sterile dressings, or like functions which require professional health-care training or the regular supervision of a trained health-care professional to perform. A licensed health-care professional includes (but is not limited to) a doctor of medicine or osteopathy, a registered nurse, a licensed practical nurse, or a physical therapist licensed to practice by a State or political subdivision thereof.

(3) The term “under the regular supervision of a licensed health-care professional,” as used in paragraph (B)(2) of this section, means that an unlicensed person performing personal health-care services is following a regimen of personal health-care services prescribed by a health-care professional, and that the health-care professional consults with the unlicensed person providing the health-care services at least once each month to monitor the prescribed regimen. The consultation need not be in person; a telephone call will suffice.

(4) A person performing personal health-care services who is a relative or other member of the veteran’s household is not exempted from the requirement that he or she be a licensed health-care professional or be providing such care under the regular supervision of a licensed health-care professional.

(5) The provisions of paragraph (B) of this section are to be strictly construed. The higher level aid-and-attendance allowance is to be granted only when the veteran’s need is clearly established and the amount of services required by the veteran on a daily basis is substantial. (Authority: 38 U.S.C. 501(a), 1114®(2))

© Attendance by relative. The performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his or her household will not prevent the granting of the additional allowance.

yeah, thats the one I think...

[Guest RickB54]

Placed a claim for lou of use of lower extremities which is being caused by my S/C disabilities. Recieaved letter from VA saying that they got my claim. Enclosed was a paper informing me that if order to get the smc at the R2 I must present a statement from a licensed health care. Well my civilian doctor put me in a home exercise program for my back,legs and hips for which my wife is supervising and my physical therapiest is going to check twice a month. Need soem kind of advice on what to do.Thanks.

Im a little confused, you ask about loss of use of lower extremities, than talk about some kind of exercise program.

1. In order to be rated loss of use, you must have actually lost the lower limbs to amputation, or;

2. you must have actually loss the use of the lower limbs as example to nerve damage such as a foot drop where the foot is still attached but it does not fuction properly.

You will need a nerve conductive test to determine the latter condition. The va will only award SMC if you can show that the loss of use is due to a service connected medical condition, and it will usually also require you to attend a c/p exam.

If you are able to exercise, where is the loss of use, did I miss something?

[sixthscents]

Good point Rick but you havent been following Windy's story.. there is nerve damage as shown on an EMG if I remember correcctly. He wears AFO's on both legs if I remember correctly as well. Its service connected already hes just trying to resolve the loss of use and SMC rate. Personally I dont think the R2, or R1 will pan out Windy... L rate sure, L 1/2 based on you other stuff, but unless there's something like bowel or bladder involvement or something requiring continuous care, such as inability to stand... or track meds etc, or a combination... I think they are going to hit you with L1/2.. actually probably L until you point out the additional 50 percent portion of CFR 38 3.350.

Let me know the specifics of the other stuff again buddy I am sorry but I'm having a bad day and cant pull them up... not the afo, etc I got that, but the other injuries/illnesses...

I may be thinking of another claimant entirely, and if so I'm sorry but I think this is the deal.

[Guest RickB54]

Sounds to me like he should be awarded two k awards unless he has other issues that also entitle him to smc's.

[sixthscents]

Actualy Rick for loss of use of one extremety K is awarded, but loss of use of two is an L award... Under CFR 38 (of course) 3.350

(B) Ratings under 38 U.S.C. 1114(l). The special monthly compensation provided by 38 U.S.C. 1114(l) is payable for anatomical loss or loss of use of both feet, one hand and one foot, blindness in both eyes with visual acuity of 5/200 or less or being permanently bedridden or so helpless as to be in need of regular aid and attendance.

now this also includes the creative organ as an appendage (appropriately I think) and defines what requirements must be meant for loss of use of it.

OK so, L here is a given IF and ONLY IF loss of use of two appendages is proven... now actual loss is not necessary, but loss of use is.. does that make sense... heck you know what I mean. In case others wonder though again CFR 38 .. 3.350

(2) Foot and hand.

(i) Loss of use of a hand or a foot will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function, whether the acts of grasping, manipulation, etc., in the case of the hand, or of balance, propulsion, etc., in the case of the foot, could be accomplished equally well by an amputation stump with prosthesis; for example:

I think this is actually Windys probable condition from what I remember.

Now just loss of use of one foot is a 40% rating with a k SMC just like you said, but for 2 it goes to L unless there is loss of NATURAL KNEE ACTION due to a lower brace or actual damage.... in either case that an M rate....

again CFR 38 3.350 pretty much outlines most of SMC with 3.351, 3.352-3.363

[windy city]

Actualy Rick for loss of use of one extremety K is awarded, but loss of use of two is an L award... Under CFR 38 (of course) 3.350

(B) Ratings under 38 U.S.C. 1114(l). The special monthly compensation provided by 38 U.S.C. 1114(l) is payable for anatomical loss or loss of use of both feet, one hand and one foot, blindness in both eyes with visual acuity of 5/200 or less or being permanently bedridden or so helpless as to be in need of regular aid and attendance.

now this also includes the creative organ as an appendage (appropriately I think) and defines what requirements must be meant for loss of use of it.

OK so, L here is a given IF and ONLY IF loss of use of two appendages is proven... now actual loss is not necessary, but loss of use is.. does that make sense... heck you know what I mean. In case others wonder though again CFR 38 .. 3.350

(2) Foot and hand.

(i) Loss of use of a hand or a foot will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function, whether the acts of grasping, manipulation, etc., in the case of the hand, or of balance, propulsion, etc., in the case of the foot, could be accomplished equally well by an amputation stump with prosthesis; for example:

I think this is actually Windys probable condition from what I remember.

Now just loss of use of one foot is a 40% rating with a k SMC just like you said, but for 2 it goes to L unless there is loss of NATURAL KNEE ACTION due to a lower brace or actual damage.... in either case that an M rate....

again CFR 38 3.350 pretty much outlines most of SMC with 3.351, 3.352-3.363

Sixthscent,

Thanks for your reply. First of all I been diagnosed with Fibromyalia rated at 40 %, this affects my lower back, hips and knees, second I have ddd at my L5-S1, third I had a MRI which says I have a left far lateral/forminal disc protrusion and finally during a c/p exam the doctor also stated that I have fibromyositis on both of my knees and ankles.I have to wear bilateral knees braces, AFO's and use a cane to walk because of my gait, all these accesories prescribed by my va doctor.The exercise program was prescribed so that I will not continue to loss of range of motion.Because of all these problems it makes difficult for me to walk or get up without assistance.Thanks